Provider Demographics
NPI:1255443651
Name:EBBERWEIN, CHRISTOPHER A (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:A
Last Name:EBBERWEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10222 W CENTRAL AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-4613
Mailing Address - Country:US
Mailing Address - Phone:316-773-9525
Mailing Address - Fax:316-773-2012
Practice Address - Street 1:10222 W CENTRAL AVE STE 202
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-4613
Practice Address - Country:US
Practice Address - Phone:316-773-9525
Practice Address - Fax:316-773-2012
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1136103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100453590AMedicaid
KS119872Medicare ID - Type Unspecified
KS100453590AMedicaid